Provider Demographics
NPI:1912506288
Name:LEE COMMUNITY HOME HEALTHCARE INC
Entity type:Organization
Organization Name:LEE COMMUNITY HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-800-4861
Mailing Address - Street 1:1408 SE 17TH AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3801
Mailing Address - Country:US
Mailing Address - Phone:239-800-4861
Mailing Address - Fax:239-800-4861
Practice Address - Street 1:1408 SE 17TH AVE STE E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3801
Practice Address - Country:US
Practice Address - Phone:239-800-4861
Practice Address - Fax:239-800-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110218400Medicaid